Health Objectives for the Nation
Attempted Suicide Among High School Students --
United States, 1990

Suicide rates for adolescents 15-19 years of age have
quadrupled from 2.7 per 100,000 in 1950 to 11.3 in 1988 (1,2). Data
from earlier decades are not available to assess similar trends in
rates of attempted suicide in this population. Attempted suicide is
a potentially lethal health event, a risk factor for future
completed suicide, and a potential indicator of other health
problems such as substance abuse, depression, or adjustment and
stress reactions (3). This report examines self-reported data to
estimate the annual prevalence of suicidal thoughts and behaviors
among U.S. high school students.

The national school-based Youth Risk Behavior Survey (YRBS) is
one component of CDC's Youth Risk Behavior Surveillance System,
which periodically measures the prevalence of priority health-risk
behaviors among youth through comparable national, state, and local
surveys (4). The school-based YRBS used a three-stage sample design
to obtain a representative sample of 11,631 students in grades 9-12
in the 50 states, the District of Columbia, Puerto Rico, and the
Virgin Islands. Students were asked whether they had seriously
thought about attempting suicide during the 12 months preceding
the survey, whether they had made a specific plan about how they
would attempt suicide, how many times they had actually made a
suicide attempt, and whether their suicide attempt(s) resulted in
an injury or poisoning that had to be treated by a doctor or nurse.

For the 12 months preceding the survey, 27.3% of all students
in grades 9-12 reported that they had thought seriously about
attempting suicide (Table 1). Fewer students (16.3%) reported that
they had made a specific plan to attempt suicide. About half the
students who made a specific plan (8.3% of all respondents)
reported that they actually attempted suicide. Two percent of the
students reported that they made a suicide attempt that resulted in
an injury or poisoning requiring medical attention. This systematic
decline was noted for both male and female students and for white,
black, and Hispanic students.

Female students were significantly more likely than male
students to report that they had thought seriously about attempting
suicide, had made a suicide plan, or had attempted suicide one or
more times during the 12 months preceding the survey (Table 1).
Similarly, 2.5% of female students and 1.6% of male students
indicated they had made a suicide attempt that required medical
attention, but this difference was not statistically significant.

Hispanic and white students reported higher levels of suicidal
thoughts and behaviors than black students (Table 1), although
these differences were not always statistically significant.
Hispanic female students (14.9%) were significantly more likely to
have attempted suicide during the 12 months preceding the survey
than white female (10.1%) or black female students (8.2%).
Reported by: Div of Injury Control, National Center for
Environmental Health and Injury Control; Div of Adolescent and
School Health, National Center for Chronic Disease Prevention and
Health Promotion, CDC.

Editorial Note

Editorial Note:In past surveys assessing the lifetime prevalence of
attempted suicide, 9% (5,6) to 14% (7) of adolescents reported that
they had attempted suicide at some time in their lives. Few studies
have tried either to quantify the health impact of an adolescent's
self-reported attempted suicide or to determine whether high school
students' perception of a suicide attempt includes overt injury or
other sequelae. The findings reported here add to increasing
evidence that most self-reported suicide attempts among adolescents
and young adults do not result in injury or hospitalization (6). In
addition, a recent investigation among college students found that
only half of those who sought medical care for injuries sustained
during a suicide attempt were admitted to a hospital for one or
more nights (8). These findings suggest that future studies of
attempted suicide among adolescents should also assess the medical
consequences of self-reported suicidal behavior.

YRBS data indicate an estimated 276,000 high school students
in the United States made at least one suicide attempt requiring
medical attention during the 12 months preceding the survey (9).
The national health objective for the year 2000 (objectives 6.2 and
7.8) is to ``reduce by 15 percent the incidence of injurious
suicide attempts among adolescents aged 14 through 17'' (10). The
YRBS data do not permit a precise calculation of this incidence
rate because some students may have made more than one suicide
attempt requiring medical attention during the 12 months preceding
the survey. However, using the annual prevalence of U.S. high
school students who made at least one suicide attempt requiring
medical attention as a proxy, the annual prevalence will need to be
reduced from 2.1% of high school students in 1990 to 1.8% by the
year 2000 to meet the objective.

A variety of youth suicide prevention strategies have been
suggested to reduce known risk factors for suicide (e.g., social
isolation, depression, alcohol and other drug use, and access to
lethal means for suicide) and to increase referrals of high-risk
adolescents to appropriate mental health services (3). These
strategies include educating youth about the warning signs of
suicide and about suicide prevention services and training those
who work with youth to identify high-risk youth and refer them to
prevention services (e.g., crisis centers, hotlines, and other
crisis services). These strategies have not been widely
implemented, however, and little is known about their relative
effectiveness. Evaluation research is needed to help identify the
most effective means for preventing attempted and completed suicide
among youth.

References

CDC. Youth suicide in the United States, 1970-1980. Atlanta: US
Department of Health and Human Services, Public Health Service,
1986.

American School Health Association/Association for the
Advancement of Health Education/Society for Public Health
Education, Inc. The National Adolescent School Health Survey: a
report on the health of America's youth. Oakland, California: Third
Party Publishing Co., 1989:31.

Bureau of the Census. School enrollment--social and economic
characteristics of students: October 1988 and 1987. Washington, DC:
US Department of Commerce, Bureau of the Census, 1990:443. (Current
population reports; series P-20).

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